Should I be concerned about testicular atrophy or fertility issues with an elevated FSH level and high Testosterone?

Your Hormone Profile and Testicular Parameters Are Reassuring

Based on your excellent sperm parameters (184 million total count, 50% progressive motility) and normal testicular volumes (10ml bilaterally), you do not need to be concerned about testicular atrophy or fertility issues, despite your FSH of 10 IU/L. Your semen analysis demonstrates robust spermatogenesis that directly contradicts any clinically significant testicular dysfunction 1.

Understanding Your Hormone and Fertility Profile

Your Sperm Parameters Are Excellent

• Your total sperm concentration of 184 million per ejaculate far exceeds the WHO lower reference limit of 39 million total sperm per ejaculate, indicating normal testicular function 1.
• Progressive motility of 50% is well above the WHO lower reference limit of 32%, demonstrating healthy sperm production 1.
• The combination of normal sperm concentration, motility, and total count is more predictive of testicular function than any single hormone measurement, including FSH 1.

Your FSH Level of 10 IU/L Is Mildly Elevated But Not Concerning

• FSH levels above 7.6 IU/L indicate some degree of testicular stress, but your FSH of 10 IU/L is only mildly elevated and does not predict infertility when sperm parameters are normal 1, 2.
• FSH levels alone cannot definitively predict fertility status—your actual sperm production proves your testes are functioning well 1, 2.
• Men with FSH levels in your range typically have oligospermia (reduced counts), not the excellent counts you demonstrate 2.
• Your elevated testosterone (35 nmol/L) and normal LH (7 IU/L) argue strongly against primary testicular failure, which would show low testosterone with elevated LH 1, 2.

Your Testicular Volume of 10ml Bilaterally Requires Context

• Testicular volumes of 10ml fall just below the 12ml threshold that defines testicular atrophy, but this must be interpreted alongside your excellent sperm parameters 3.
• Mean testicular size strongly correlates with total sperm count and sperm concentration—your high sperm counts indicate your testicular volume is functionally adequate 3, 4.
• The 12ml cutoff is a statistical threshold, not an absolute dividing line between normal and abnormal function 3.
• Your bilateral symmetry (both 10ml) is reassuring, as size discrepancy greater than 2ml or 20% would warrant further evaluation 3.

Why You Should Not Be Worried Long-Term

Your Semen Analysis Proves Normal Testicular Function

• Semen abnormalities associated with true testicular atrophy are typically consistent across multiple analyses and would show severely reduced counts, not the 184 million you demonstrate 1.
• Testicular atrophy with elevated FSH above 7.6 IU/L is strongly associated with spermatogenic failure—your excellent sperm production proves this is not occurring 1.
• The assessment of combined ejaculate parameters (concentration, motility, total count) is more predictive of testicular function than testicular volume measurements 1.

Your Hormone Pattern Does Not Suggest Progressive Dysfunction

• Your normal LH (7 IU/L) and high testosterone (35 nmol/L) indicate your Leydig cells are functioning normally and your hypothalamic-pituitary-gonadal axis is intact 1, 2.
• Primary testicular failure would show low testosterone with markedly elevated LH and FSH (typically FSH >15-20 IU/L), which is not your pattern 2.
• Your mildly elevated FSH likely represents compensatory feedback to maintain your excellent sperm production, not progressive testicular failure 1, 2.

Recommended Monitoring and Actions

Repeat Semen Analysis in 3-6 Months

• Perform repeat semen analysis to establish whether your sperm parameters are stable or declining, as single analyses can be misleading due to natural variability 1, 2.
• If parameters remain stable or improve, this confirms your testicular function is adequate despite the mildly elevated FSH 1.

Consider Reversible Causes of Mildly Elevated FSH

• Check thyroid function (TSH, free T4), as thyroid dysfunction can disrupt the hypothalamic-pituitary-gonadal axis and elevate FSH 1, 2.
• Assess for metabolic factors including BMI, as obesity and metabolic stress can affect gonadotropin levels 1.
• Review medications, as certain drugs (opioids, corticosteroids, anabolic steroids) can suppress the hypothalamic-pituitary-gonadal axis 1.

Avoid Testosterone Therapy

• Never start exogenous testosterone therapy if you desire future fertility—it will completely suppress FSH and LH through negative feedback, causing azoospermia that can take months to years to recover 1, 2.
• Your high testosterone of 35 nmol/L does not require treatment and likely reflects normal Leydig cell function 1.

Monitor for Testicular Cancer Risk

• Men with testicular volumes <12ml have increased risk of testicular cancer and should perform monthly testicular self-examination 1, 3.
• Seek immediate evaluation if you develop a palpable testicular mass, rapid testicular size change, or new testicular pain 1, 3.
• Testicular biopsy is NOT indicated at this time given your normal fertility, but would be considered if you develop a testicular mass or progress to severe oligospermia (<5 million/mL) 1, 3.

Common Pitfalls to Avoid

• Do not interpret FSH in isolation—your excellent sperm parameters prove your testes are functioning well despite the mildly elevated FSH 1, 2.
• Do not assume testicular volume of 10ml means progressive atrophy—functional capacity (demonstrated by your sperm production) matters more than absolute volume 1, 3, 4.
• Do not pursue aggressive hormonal treatments (FSH injections, aromatase inhibitors, SERMs) when sperm parameters are already excellent—these have limited benefits and are outweighed by assisted reproductive technology if fertility issues arise 1, 2.
• Do not delay fertility plans unnecessarily—while your current parameters are excellent, consider sperm cryopreservation if you anticipate delaying fatherhood for many years 2.